Abstract
Clinicians frequently face the decision of whether to continue aspirin when starting patients on warfarin. We performed a meta-analysis to characterize the tradeoffs involved in this common clinical dilemma. Multiple computerized databases (1966 to 2003), reference lists of relevant articles, conference proceedings, and queries of primary authors. Randomized trials comparing warfarin plus aspirin versus warfarin alone. Studies with target international normalized ratios (INRs) <2 were excluded. Two reviewers independently extracted baseline data and major outcomes: rates of thromboembolism, hemorrhage, and all-cause mortality. Nine studies met the inclusion criteria. Of the five that enrolled patients with mechanical heart valves, four used the same target INR in both groups, while one used a reduced target INR for the warfarin plus aspirin group. Pooling the results of the first four studies demonstrated that combination of warfarin plus aspirin significantly decreased thromboembolic events (relative risk [RR], 0.33; 95% confidence interval [CI], 0.19 to 0.58), increased major bleeding (RR, 1.58; 95% CI, 1.02 to 2.44), and decreased all-cause mortality (RR, 0.43; 95% CI, 0.23 to 0.81) compared to warfarin alone. The one valve ...Continue Reading
References
Jul 1, 1977·American Heart Journal·J DaleL Efskind
Jul 1, 1976·The Journal of Thoracic and Cardiovascular Surgery·R AltmanR Favaloro
Dec 12, 1992·Lancet·S Juul-MöllerR Omblus
Jul 20, 1989·The New England Journal of Medicine·UNKNOWN Steering Committee of the Physicians' Health Study Research Group
Jun 1, 1980·American Heart Journal·J DaleD Loew
Jul 6, 1995·The New England Journal of Medicine·S C CannegieterE Briët
Apr 1, 1995·Journal of the American College of Cardiology·M HerasF J Puga
Nov 1, 1994·Arteriosclerosis and Thrombosis : a Journal of Vascular Biology
Jul 11, 1994·Archives of Internal Medicine
Jan 8, 1994·BMJ : British Medical Journal
Feb 1, 1994·Circulation·S C CannegieterE Briët
Aug 19, 1993·The New England Journal of Medicine·A G TurpieJ Hirsh
Jun 15, 1996·Circulation·J Hirsh, J Hoak
May 1, 1997·The Journal of Thoracic and Cardiovascular Surgery·S S MeschengieserM A Lazzari
Jul 7, 1999·Cerebrovascular Diseases·R G HartL A Pearce
Sep 1, 1999·Circulation·T J RyanS C Smith
Oct 3, 1999·Annals of Internal Medicine·R G HartL A Pearce
Nov 30, 1999·Annals of Internal Medicine·R G Hart, J L Halperin
Dec 11, 1999·JAMA : the Journal of the American Medical Association·S S Anand, S Yusuf
Jan 13, 2000·Journal of General Internal Medicine·J B SegalE B Bass
Mar 15, 2000·Journal of the American College of Cardiology·P LaffortE Baudet
Feb 7, 2001·Chest·J HirshD Deykin
Feb 24, 2001·Journal of the American College of Cardiology·D Massel, S H Little
Jun 27, 2001·Circulation·T HuynhS Solymoss
Aug 29, 2001·CNS Drugs·M Yasaka, T Yamaguchi
Aug 29, 2001·The American Journal of Cardiology·C M O'ConnorV Fuster
Oct 20, 2001·Cerebrovascular Diseases·P LechatUNKNOWN FFAACS (Fluindione, Fibrillation Auriculaire, Aspirin et Contraste Spontané) Investigators
Dec 1, 2001·Clinical Therapeutics·A H Abdelhafiz
Feb 6, 2002·Circulation·Louis D FioreUNKNOWN Combination Hemotherapy and Mortality Prevention (CHAMP) Study Group
Mar 20, 2002·Circulation·Marc A Brouwer, Freek W A Verheugt
Jul 20, 2002·Lancet·Robert F van EsUNKNOWN Antithrombotics in the Secondary Preventionof Events in Coronary Thrombosis-2 (ASPECT-2) Research Group
Sep 27, 2002·The New England Journal of Medicine·Mette HurlenHarald Arnesen
Nov 19, 2002·JAMA : the Journal of the American Medical Association·Carl van WalravenBeppie Hellemons
Citations
Apr 27, 2012·International Journal of Clinical Pharmacy·Cristiano S MouraFrancisco A Acurcio
Feb 18, 2011·Journal of Thrombosis and Thrombolysis·Tiago L L LeiriaJohn H Alexander
May 23, 2012·European Heart Journal·John J V McMurrayUNKNOWN ESC Committee for Practice Guidelines
Jul 24, 2007·Blood·David A GarciaMark A Crowther
May 23, 2007·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Natalie OakeCarl van Walraven
Jul 30, 2008·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Natalie OakeCarl van Walraven
Aug 4, 2012·International Journal of Medical Sciences·Takao TamuraYasushi Okuno
Dec 7, 2014·Journal of Huazhong University of Science and Technology. Medical Sciences = Hua Zhong Ke Ji Da Xue Xue Bao. Yi Xue Ying De Wen Ban = Huazhong Keji Daxue Xuebao. Yixue Yingdewen Ban·Jian-Tang WangSheng-Jun Ma
Aug 5, 2011·Thrombosis Research·Ming-Feng DongLe-Xin Wang
Mar 1, 2011·Blood Reviews·Jeremy S PaikinJohn W Eikelboom
Aug 18, 2009·Lancet·Jack C J SunJohn W Eikelboom
Aug 1, 2007·Journal of Thrombosis and Haemostasis : JTH·J W Eikelboom, J Hirsh
Jul 26, 2012·European Journal of Heart Failure·John J V McMurrayUNKNOWN ESC Committee for Practice Guidelines
Jul 6, 2016·The Canadian Journal of Cardiology·Dae Hyun Kim, Michael W Rich
Oct 3, 2008·Thrombosis Research·S Johnson
Sep 30, 2008·Thrombosis Research·M Dowd
Apr 6, 2007·The Journal of International Medical Research·I BiyikO Oto
Nov 3, 2017·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Gregory Y H LipUNKNOWN ESC Scientific Document Group
Jan 18, 2013·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Charles E MahanWinslow Klaskala
Sep 25, 2017·International Journal of Clinical Practice·Patrick ManckoundiaAlain Putot
Mar 21, 2009·Stroke; a Journal of Cerebral Circulation·Anthony J Furlan
Mar 31, 2016·Applied Health Economics and Health Policy·Manal H El-HamamsyHossam Elmansy
Jun 16, 2018·Journal of the American College of Cardiology·Richard P WhitlockJohn W Eikelboom